New hope for kidney disease patients in San Antonio
Dr. Brian Reeves, chairman of the Department of Medicine, is quoted in this story.
New hope for kidney disease patients in San Antonio
Lauren Caruba and Laura Garcia, July 13, 2019
Pat Hernandez is waiting.
For nearly six years, she has been on the transplant list at University Hospital as a candidate for a new kidney after her uncontrolled high blood pressure caused renal failure.
In the meantime, Hernandez, 53, has spent countless hours at a San Antonio dialysis center, where a machine filters waste, toxins and fluids from her blood three times a week. She learned recently from her doctor that she’s finally moved to the top 20 percent of the waiting list.
More than 2,500 people are waiting for a kidney in South Texas, where it can take up to eight years to get a transplant.
Hernandez’s situation is emblematic of the larger problems of caring for patients with kidney disease, which affects about 37 million Americans.
The Trump administration this week announced a sweeping plan to tackle kidney disease at all stages, from prevention efforts to the delivery of dialysis to the backlogged transplant system.
Outlined in a paper by the U.S. Department of Health and Human Services, the initiative’s goals are to reduce kidney failure rates by 25 percent and double the available kidneys for transplant by 2030. The majority of new kidney failure patients by 2025 would either get a transplant or receive dialysis at home, rather than at a clinic.
President Donald Trump paired the plan with an executive order that promised to raise public awareness of kidney disease, reform the organ procurement system, encourage living kidney donations by covering donors’ lost wages and child care costs and support efforts to develop alternatives to transplants, like implantable artificial kidneys.
Jennifer Milton, executive director of University’s transplant program, said she appreciated how much the plan emphasized prevention efforts like early detection and screening, because the majority of people with kidney disease don’t know they have it.
“It’s a system that pays for kidney health rather than a system that pays for kidney sickness,” she said about the plan.
Chronic kidney disease is very costly, primarily from expenses related to dialysis. The federal government pays up to 80 percent of the dialysis costs for most patients. Medicare spent $114 billion in 2016 treating people with chronic kidney disease, accounting for more than 1 in 5 dollars spent by the federal health program.
A major part of the plan relies on the Innovation Center, a program created by the Affordable Care Act that includes financial incentives for dialysis facilities and physicians to encourage their patients to choose home dialysis and kidney transplantation over costlier treatments at clinics, which average $89,000 annually.
Dr. Brian Reeves, chairman of the department of medicine at UT Health San Antonio, said the initiative seems to make sense for patients, donors and ultimately for the taxpayers.
As a kidney doctor for the past 40 years, Reeves said he wouldn’t call the plan an overhaul but acknowledged that it would introduce welcome changes that could prevent the disease.
A ‘silent killer’
Nationwide, kidney disease is the ninth-leading cause of death. More than 240 people on dialysis die every day, according to the Centers for Disease Control and Prevention.
In South Texas, where diabetes and hypertension are widespread, there are higher rates of kidney failure, which disproportionately affects the Hispanic and African American populations.
The changes proposed by the Trump administration could mean fewer people in the future will endure long-term dialysis or die from end-stage renal disease, often referred to as a “silent killer.”
It has gotten that moniker because symptoms do not show up until the kidneys have been permanently damaged. But politicians also don’t talk about kidney disease as often as other public health problems, such as cancer or heart disease, some doctors say.
“Our disease never gets attention,” said Dr. Qasim Ali Butt, a nephrologist with the South Texas Renal Care Group. “The sheer fact of the president acknowledging it… that’s actually a big deal.”
Patti Gomez, area operations director for Fresenius Medical Care, which operates dialysis centers, said the staff is excited that kidney care is getting so much attention now. The plan also reinforces the Germany-based company’s push for expansion of its in-home dialysis services.
“The outcomes are better at home and the patients thrive a lot more than they do at the centers,” she said.
Patients undergoing the at-home treatment, called peritoneal dialysis, are able to have more flexible work and travel schedules than those treated at the clinics.
Still, not everyone medically qualifies for at-home treatment or is a candidate for transplant, she added.
Improving transplant rates
Across the country, nearly 95,000 people are waiting for a new kidney, including more than 8,000 in Texas. But due to the scarcity of organs, many people die waiting for a transplant. Last year, about 21,000 kidneys were transplanted nationwide.
Increasing the number of available kidneys for transplant has been much talked about in the transplant community over the past several years.
The federal government’s plan calls for maximizing the number of available kidneys by boosting organ recovery and reducing the organ discard rate — that is, kidneys recovered from deceased donors but are not transplanted. According to the report, about 18 to 20 percent of procured kidneys fall into that category.
It would also update federal guidelines for using organs from donors with HIV, hepatitis B and hepatitis C and refine a new model to more quickly transplant organs that “are at high risk for discard.”
Organ procurement organizations, which are federally designated nonprofits that recover and preserve organs from deceased donors, would also see changes.
Other parts of the plan involve easing financial barriers to living kidney donation by expanding a pilot reimbursement program that covers some expenses for such donors. While they don’t have to pay for the surgery, they may face other costs, including transportation and lost wages during the typical four weeks it takes to recover.
Milton, University’s transplant director, said many private insurance companies will not cover all the costs related to a living donor’s surgery, including all follow-up appointments. She said she hoped the government would increase accountability over private insurers.
Hernandez, while waiting for a kidney, has kept a positive outlook rather than dwell on the “daily rut of being on dialysis.” She said she was encouraged by aspects of the federal plan to help patients like her.
“My godbrother got a transplant and he told me he said he woke up, he felt the immediate difference,” she said. “I’m looking forward to that.”